title: Changing epidemiology of candidemia in a medical center in middle Taiwan.
abstract: BACKGROUND
  Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.
  
  
  METHODS
  Clinical and laboratory data from patients with candidemia were collected retrospectively at a tertiary medical center in Taiwan from July 1, 2009 to June 30, 2012 (a 36-month period). Demographics, clinical characteristics, and drug susceptibility of the invading Candida species of patients at the onset of candidemia were analyzed and compared with previous study from January 1, 2001 to June 30, 2003 (a 30-month period).
  
  
  RESULTS
  A total of 209 episodes of candidemia in 205 patients were identified in this study period. When compared with the previous study period, more patients were admitted for medical conditions at percentages ranging from 49.5% to 69.8%; the incidence rate of health care-associated candidemia increased from 0.76 to 1.14 per 1000 discharges; the proportion of Candida albicans in patients with candidemia decreased from 64.8% to 43.6% whereas the proportion of Candida glabrata increased greatly from 1.1% to 21.6% and the proportions of Candida tropicalis and Candida parapsilosis were slightly elevated (19.8-22.0% and 2.2-7.3%, respectively). All of the C. albicans isolates remained susceptible to fluconazole, whereas 66.7% of C. glabrata isolates were dose-dependent susceptible, and 4.4% of C. glabrata isolates and 11.6% C. tropicalis isolates were resistant. There was one C. glabrata and one Candida guilliermondii resistant to echinocandin. The predictors for 30-day mortality included the high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, use of parenteral nutrition, underlying malignancy, liver cirrhosis, and neutropenia whereas candidemia by C. parapsilosis or C. glabrata is a favorable predictor when compared with C. albicans.
  
  
  CONCLUSIONS
  The distribution of Candida species in candidemia was changed. Although C. albicans remained the major species, the isolation of non-C. albicans spp., especially C. glabrata, increased. Patients with candidemia still had high mortalities due to severity of illness and underlying conditions.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Ing-Moi
authors.initials: IM
authors.lastname: Hii
authors.affiliation: Infection Control Committee, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Hui-Lan
authors.initials: HL
authors.lastname: Chang
authors.affiliation: Infection Control Committee, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Li-Chen
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yuag-Meng
authors.initials: YM
authors.lastname: Liu
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chun-Eng
authors.initials: CE
authors.lastname: Liu
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Chang-Hua
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: Yu-Ren
authors.initials: YR
authors.lastname: Cheng
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 106018@cch.org.tw.
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Antifungal susceptibility; Candida species; Candidemia